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Risk of acute coronary syndrome and peripheral arterial disease in chronic liver disease and cirrhosis: A nationwide population-based study

  • Shih-Yi Lin
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan

    Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
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  • Cheng-Li Lin
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Cheng-Chieh Lin
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan

    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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  • I-Kuan Wang
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan

    Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
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  • Wu-Huei Hsu
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan

    Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
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  • Chia-Hung Kao
    Correspondence
    Corresponding author. Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan

    Department of Nuclear Medicine, China Medical University Hospital, Taichung, Taiwan

    Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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      Highlights

      • The overall incidence rates of acute coronary syndrome (ACS) and peripheral arterial disease (PAD) were 2.81 and 2.97 per 1000 person-years, respectively, in the cirrhosis cohort.
      • The cirrhosis cohort had a significantly higher risks of ACS (adjusted subhazard ratio (aSHR) = 1.12) and PAD (aSHR = 1.11).

      Abstract

      Background & aims

      Until now, no study has investigated the risks of acute coronary syndrome (ACS) and peripheral arterial disease (PAD) in cirrhosis.

      Methods

      In this study, 57,214 patients diagnosed with cirrhosis between 2000 and 2010 were identified from the Taiwan National Health Insurance claims data. Each patient was randomly selected and frequency-matched with an individual without cirrhosis by age, sex, and index year.

      Results

      The overall incidence rates of ACS and PAD were 2.81 and 2.97 per 1000 person-years, respectively, in the cirrhosis cohort. The cirrhosis cohort had a higher risk of ACS [adjusted subhazard ratio (aSHR) = 1.12, 95% confidence interval (CI) = 1.03–1.22] and PAD (aSHR = 1.11, 95% CI = 1.02–1.21). The risk of ACS was highest among members of the cirrhosis cohort with ascites (aSHR = 1.09, 95% CI = 1.11–1.19).

      Conclusions

      Patients with chronic liver disease and cirrhosis have higher risks of ACS and PAD than those without chronic liver disease and cirrhosis.

      Keywords

      Abbreviations:

      ACS (acute coronary syndrome), PAD (peripheral arterial disease), aSHR (adjusted subhazard ratio), HBV (hepatitis B virus), HCV (hepatitis C virus (HCV)), NHIRD (National Health Insurance Research Database), ICD-9-CM (International Classification of Diseases), Ninth Revision (Clinical Modification), CLDC (chronic liver disease and cirrhosis)
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